Fresh ideas for social housing

Turning around George: A success worth repeating

I hope all of you saw Ben Spurr’s excellent article in the August 11thStar, “Making social housing work: a TCHC success story.” The article describes the turnaround of 291 George Street — a 132-unit building that even street-hardened men were too scared to live in — into a clean and decent home.

If anything, the article downplays the building’s success. In just one year after the “turnaround pilot” was introduced:

Violent Calls for Service to the police dropped 56% from the preceding three year average

Calls to TCHC’s own Community Safety Unit were down 64% from the preceding year

Units with major clutter, pest infestations or fire hazards dropped to zero

Twenty-four tenants were connected with a family doctor, and many others were referred to other support services

Roughly half the tenants living in the building were participating regularly in some sort of community activity, such as tenant meetings or the Breakfast Club, drop-in, tax clinics or holiday celebrations the pilot brought to the building’s community room.

As the building became safer, vacancy rates were cut in half. And as tenants became more engaged, the building became noticeably cleaner and better maintained.

The Star article rightly praises TCHC’s excellent front-line staff for their good work. But it would be a mistake to think this sort of success is possible only with exceptional staff. Instead, 291 George’s success can be replicated in TCHC and buildings across Ontario. Here’s what it takes.

1. Health funders step forward

The “291 George turnaround” began when the Toronto Central Local Health Integration Network (TC-LHIN), one of 14 networks that channel provincial health funding to hospitals and community health agencies, stepped forward with a one-time Community Investment Allocation.

The TC-LHIN has long recognized that just 1% of the population accounts for 30% of health spending, and people who live in poverty, are isolated, have been homeless or have a mental health or addiction issue are among those most of risk of becoming part of that 1%.

The TC-LHIN studied emergency room visits from the postal code that includes 291 George Street and found one of the highest rates of emergency room use Canada. Every emergency room visit is estimated to cost $291 (2006 figures); every hospitalization costs an estimated $842 per day.

The cost of the entire George Street one-year pilot worked out to $1,272 per unit for on-site staff, $163 for extra security, $362 for direct costs like “extreme cleaning” for cluttered units and replacements for bedbug infested beds; and $314 for project administration and evaluation. Costs have been reduced in the project’s second year.

That’s cheap compared to hospitals or hostels. But it’s also cheap in comparison to other support programs. For example, the nationally-acclaimed At Home/Chez Soi project, another health-funded initiative to house formerly homeless people such as those who live on George Street, cost $7,531 per year for each person with moderate needs — $14,731[1] if the cost of a $7200 per year rent supplement is included.

2. A “whole building” approach

Many George Street tenants had been matched with case workers, social workers, visiting nurses and other professionals over the years. But some of these professional stopped visiting because they were mandated to provide only short-term supports, or their agency deemed the building too unsafe to visit. Others continued to visit but had neither the mandate nor the expertise to deal with pest infestations, a predatory drug-dealer or all the other issues that are central to their client’s health and wellbeing.

The pilot project took a different approach. It worked with the community as a whole, bringing two full-time staff and 24/7 security right into the building. These workers kept their eyes on the lobby, walked the hallways, were right there in a crisis, and could see problems emerging before they became crises. Isolated tenants began to come out of their units. Trust grew, and so did safety.

On-site staffing can also improve service co-ordination. A 2014 needs assessment in two neighbouring TCHC building found the 174 tenants surveyed received services from 130 different organizations, including 62 mental health agencies, 32 addictions agencies, 20 home care agencies and 9 health services. Even so, the 631 people living in these buildings made a total of 946 Emergency Room visits in the past three years and nine out of ten tenants surveyed reported unmet needs. TCHC is now introducing an on-site resource hub in these buildings funded by the Toronto Central LHIN.

3. Housing and supports work together

Supportive housing providers know that property management and support work hand in hand. The pilot introduced two support specialists: a housing support worker from Houselink, an agency that provides over 400 supportive housing units for people with mental illness; and a community developer from Fred Victor, a local multi-service agency with its own housing portfolio.

These staff were ready to work with TCHC staff to take on the nitty-gritty work of helping a tenant prepare for bedbug treatment, following up on an after-hours emergency, negotiating a plan to repay arrears or filling out forms needed to keep rent subsidies flowing. At the same time, TCHC’s own front-line staff were an integral part of the supports: uniquely positioned to spot problems and set a friendly and helpful tone.

4. A community effort

The George Street project depended on the collaboration of many partners, each with a crucial role to play. The funding would not have been possible without Houselink, a health transfer agency, to receive the funds and co-ordinate the project. Toronto Police Services worked closely with on-site staff, increased its building patrols and conducted a tenant safety survey. The Inner City Family Health Team provided care for tenants referred through the project. A counselor from Seaton House shelter, the City’s men’s shelter next door to 291 George, was an active supporter of the project, as was local Councillor Kristyn Wong-Tam.

5. A continuing commitment

One of the greatest fears for 291 George tenants was that gains would disappear once the one-year pilot funding ran out. It’s a reasonable fear. Over the years many, many TCHC communities have had their hopes raised, only to see short-term funding evaporate as governments, foundations and corporate donors move on to the “next big thing.”

That hasn’t happened. In 2014 the TC-LHIN expanded funding to include other TCHC buildings, while retaining supports on George Street.

Time for the other LHINs to step up

I believe that TCHC has at least 20 buildings that would benefit from a “291 George-style turnaround.” The Toronto Central LHIN has taken the lead by expanding the project to other downtown buildings. Now what about the rest?

Responsibility for health funding in Toronto is divided among five LHINS. Except for the Toronto Central LHIN, each has a domain that extends far into the suburbs and beyond. That’s been a problem for TCHC. When a LHIN’s borders include both Scarborough and the Kawarthas, as the Central East LHIN’s do, it means Toronto issues can get short shrift.

And yet, now that the TC LHIN has proven what’s possible, isn’t it time for the other LHINs to have their own success story in the Star?

This kind of thing with LHIN should be encouraged across the entire TCHC portfolio. Staff at Housing can only do so much for residents, and therefore the need to partner with other agencies is essential